Korean J Crit Care Med.  2015 Nov;30(4):308-312. 10.4266/kjccm.2015.30.4.308.

Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis

• Lee HY
• Joo YY
• Oh YS
• Seo YR
• Joo HS
• Kim SC
• Rhee CK

• KMID: 2156186
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.308

Abstract

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

Keyword

airway obstruction; barotrauma; hemoptysis; ventilation

MeSH Terms

Adult
Airway Obstruction
Anemia, Aplastic
Barotrauma*
Bronchoscopy
Emergencies
Female
Hemoptysis*
Humans
Mediastinal Emphysema
Pneumothorax
Subcutaneous Emphysema
Ventilation*
Ventilators, Mechanical

Figure

• 

  Fig. 1. A chest radiograph reveals a short, thick, subsegmental atelectasis in the lingular division of the left lung. A Hickman catheter was inserted into the superior vena cava via the right internal jugular vein. RAPS: right anterior posterior supine.

• 

  Fig. 2. Bronchoscopy reveals thick blood clots running from the distal trachea (A, B) to the main carina and both bronchi (C). Forceps were used to remove the clots (D).

• 

  Fig. 3. (A) A post-intubation chest radiograph reveals aggravated atelectasis in the lingular division. (B) Diffuse subcutaneous emphysema is evident in the chest radiograph. RAPS: right anterior posterior supine.

• 

  Fig. 4. (A) Chest CT reveals extensive pneumomediastinum and subcutaneous emphysema in both thoraces. (B) Moderate pneumothorax is evident in the left lung. CT: computed tomography.

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  Fig. 5. Chest radiography reveals improvement of the subcutaneous emphysema and the pneumothorax of the left lung. R: right.

Reference

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